Frostbite

Frostbite is a cold-related injury, in which the tissues of the body freeze and become damaged. This occurs from exposure to below freezing temperatures for a long period of time. The damage is due to a lack of blood pumping to the area, which prevents the tissues from receiving oxygen. Frostbite is common in runners in cold climates, as well as athletes in winter and climbing sports (i.e. skiing, snowboarding, snowshoeing, mountaineering).

SYMPTOMS

First Stage

  • Numbness.

  • Central white area of skin, with surrounding redness.

  • Clumsiness.

  • Fluid build up(edema).

Second Stage

  • Blisters, with clear or milky fluid, developing after 24 hours.

Third Stage

  • Bloody (hemorrhagic) blisters that slowly become a hard, black scab (eschar) over 2 weeks.

Fourth Stage

  • Tissue death. Requires removal of body part (amputation).

CAUSES

Frostbite is caused by lengthy exposure to freezing temperatures.

RISK INCREASES WITH:

  • Drinking alcohol.

  • Improper clothing.

  • Prior episode of frostbite.

  • Smoking.

  • Dehydration.

  • Poor physical conditioning.

  • No previous attempt to prepare the body for cold weather (non-acclimatization).

PREVENTION

  • Wear climate-appropriate clothing.

  • Maintain general good health.

  • Stay hydrated.

  • Face away from the wind.

  • Cover your nose, ears, and hands.

  • Keep your hands inside a jacket or under your armpits.

  • Eliminate alcohol and tobacco use.

  • Wear clothing in layers.

  • Use water repellent on mittens or gloves.

  • Prevent clothes from becoming wet, with waterproof covering.

PROGNOSIS

The severity of frostbite depends mostly on the length of cold exposure. The best way to treat frostbite is to eliminate the cold exposure, before the condition progresses. Third and fourth stage frostbite may require amputation of the affected area.

RELATED COMPLICATIONS

Severe frostbite may lead to the loss of tissue, including skin, muscle, and bone, For milder cases, the affected area is usually vulnerable to recurring cold injury. Some patients experience numbness in the area for variable periods. The mildest cases (first stage) usually have no complications.

TREATMENT

  • Rapidly re-warm the area, in warm water, with precisely controlled temperature, 105° to 110° F (40° to 42° C).

  • Clean (debride) white blisters, and apply aloe vera (with no alcohol or perfume).

  • Apply loose, bulky protective covering.

  • Splint (restrain) and elevate the limb.

  • Use ibuprofen: 800 mg, 2 to 4 times per day for adults.

  • Do not smoke.

MEDICATIONS

  • A tetanus shot may be needed, if your last tetanus booster was given more than 10 years ago.

  • For severe cases, penicillin is given by injection in the vein (intravenous) for 3 days.

  • Pain medicines are used as needed.

  • Many treatments for frostbite are experimental and cannot be recommended at present.

ACTIVITY

  • Avoid re-cooling the injured area, until the area has healed completely.

  • Physical therapy to restore motion and strength is often started when swelling goes down.

DIET

Proper hydration is important in prevention.

SEEK MEDICAL CARE IF:

  • After a lengthy period of cold exposure, you experience numbness and white skin with any blister formation.

  • You have a history of frostbite and experience a new episode.

  • You have a severe episode of cold exposure, with blood-filled blisters on the area.